THE UTTARAKHAND (THE UTTARANCHAL VALUE ADDED TAX RULES, 2005) FORMS
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Body

FORM XI

(See sub-rule (1) of rule 23)

Form of Declaration by a dealer holding a Recognition Certificate

Duplicate

Serial No.----------

Date of issue-----------

Name and full address of -------------------------------------------

the dealer to whom issued -------------------------------------------

Registration Certificate No.05-----------------------------------------

Valid with effect from--------------------------------------------------

	Signature
	(Seal of the issuing authority)
	Sector-----Circle-------
(The above entries to be filled in by the issuing authority)

To.

---------------------------------

(seller)

Certified that the goods specified below purchased from you are for use as Capital Goods and raw material in the manufacture of goods or in the packing of such manufactured goods and that the said manufactured goods would be sold in the manner contemplated in sub-section (7) of section 4.

Certified that I hold the Recognition Certificate no.________issued to me/us by the Assistant Commissioner, Sector__________Circle____________ and the same is valid with effect from_________.

Certified that I/we carry on business under the name and style of____________________________________at ____________________________________(full address)

Details of goods purchased

Sr.No.	Sale Invoice/Challan		Description of goods	Quantity/weight	Value of goods
Sr.No.	Number	Date	Description of goods	Quantity/weight	Value of goods
1	2(a)	2(b)	3	4	5




				Total

Rupees_______________________________________________________(in words )

Date _________	Signature________________
	Name___________________
Place_________	Status___________________

(Note- To be issued to the selling dealer)